In Six Francophone West African Cities, Mayors Are Serious about Investing in Family Planning

In a region where increases in the use of modern contraception have been persistently sluggish, IntraHealth International is implementing TCI and focusing its efforts on areas where exponential progress is most likely: urban environments. About half of the people in the region live in cities.

Some countries in francophone West Africa still have contraceptive rates in the single digits and are home to some of the worst maternal health outcomes in the world. But Senegal and Burkina Faso have made unprecedented progress in the last ten years, and other countries are finally making headway. Global and regional efforts such as FP2020 and the Ouagadougou Partnership have worked at different levels to align donor investments, identify the greatest needs among countries, and garner domestic political will and momentum for family planning throughout the region.

TCI Accelerator Hubs work with city officials to develop proposals and select high-impact investments.

TCI is now building on these opportunities and bringing a new model of development—one that is completely driven by demand. Local government officials, such as mayors, self-select to apply for grants and must contribute some of their own financial, material, and human resources to the projects, which ensures their political commitment. In return, TCI offers technical expertise through innovation hubs as well as financial support to help cities achieve their health and economic goals through better family planning and reproductive health.

IntraHealth has served as the accelerator hub in West Africa and worked with cities in Benin, Burkina Faso, Côte d’Ivoire, and Senegal to help them launch family planning and reproductive health activities that include commitments of cities’ own resources.

In the past year:

  • Mayors and local officials from six cities (Ouagadougou, Burkina Faso; Koudougou, Burkina Faso; Union des Communes du Zou, Benin; Bouaké, Côte d’Ivoire; Nioro, Senegal; and Kolda, Senegal) announced new commitments to boost family planning and reproductive health services for their populations, in partnership with TCI.
  • Eight health districts incorporated universal family planning referral approaches and activities into their annual work plans. (These were Nioro and Kolda in Senegal; Baskuy, Bogodogo, Boulmiougou, Nongremaasom, and Sig-Nonghin in Ouagadougou, Burkina Faso; and Koudougou in Burkina Faso.)  These health districts also developed data-collection systems to help monitor their progress.
  • TCI helped train 48 trainers and more than 700 health workers in universal referral.

Fourteen programs, including five targeting youth and adolescents, are in the works for the year ahead. The project plans to reach more than 150,000 new users of modern contraception in 11 cities in five francophone West Africa countries (Benin, Burkina Faso, Côte d’Ivoire, Niger, and Senegal) in the current project year. The total population of these eleven cities is over 13 million.

TCI Accelerator Hubs, like IntraHealth’s in West Africa, work with city officials who have expressed interest to develop proposals and select the highest-impact investments cities can make.

In West Africa, this has led to the expansion of a universal referral approach called “ISBC” or identification systématique des besoins. Through this approach, every woman of reproductive age who comes to a health facility is systematically counseled on family planning and, if she is interested in more information, referred to the family planning room within the facility on the same day, regardless of the health service that brought her in.

This strategy of systematic referral—which makes the most of opportunities to provide counselling on family planning—is key to responding to unmet needs. This strategy is also cost-effective, which makes it an attractive choice to city officials. It requires only one day of orientation and training for health workers to get started, and is followed by ongoing mentoring, refreshers, and supportive supervision.

Burkina Faso

In Burkina Faso, Moussa Belem, the deputy mayor of Ouagadougou, says he was motivated to apply for TCI funding after attending the official regional launch of TCI in Dakar in February 2017. The total population of Ouagadougou is approximately 2.5 million, and the mayor’s team understands that it needs to increase access to modern contraception so that it can benefit from the demographic dividend and ensure resources such as roads, schools, and health care are available for its growing population.

Ouagadougou’s TCI activities are focused on implementing universal referral as well as reaching young people with the services they need, including by:

  • Training health workers to more effectively communicate with and understand the needs of young people.
  • Advocating to mayors and other local authorities to ensure support for reproductive health services to young people.

The city has pledged a total of 52 million West African francs (about US$92,400) to this effort. The money is reserved in a specific budget line item, and even the director of finance for the city of Ouagadougou, Sylvia Ouba Somé, is on board and excited about the initiative.

“We have pledged our own money to fund this project,” says Ouba Somé, “and you can count on us to respect our commitment.”

The Challenge Initiative is led by the Bill & Melinda Gates Institute for Population and Reproductive Health in the Department of Population, Family and Reproductive Health at the Johns Hopkins Bloomberg School of Public Health. TCI works in 11 countries through four regional implementing partners: Jhpiego in East Africa (Kenya, Tanzania, Uganda), IntraHealth in francophone West Africa (six countries), Johns Hopkins Center for Communication Programs in Nigeria, and Population Services International in India.

Published at 24-09-2018 on Vital